INFANTILE ACROPUSTULOSIS REVISITED - HISTORY OF SCABIES AND RESPONSE TO TOPICAL CORTICOSTEROIDS

Infantile acropustulosis (IA) is a condition of young children charact erized by recurrent episodes of pruritic vesicles and pustules in an a cral distribution. Several reports describe patients with scabies infe station prior to the diagnosis of IA, although the relationship betwee n the two remains unclear. Furthermore, optimal therapy is controversi al. We reviewed the history of scabies and response to therapy in 21 p atients diagnosed with IA at two institutions between 1983 and 1997. A history of prior treatment for scabies was noted in 14 patients, alth ough only two had mites, feces, or ova detected on microscopic examina tion for diagnostic verification, AII patients were treated with topic al corticosteroids (4 with class I, 12 with class II, 3 with class III , 1 with class IV, and 1 with class VI). All 18 patients who returned for follow-up experienced significant improvement or cleared completel y with treatment. There were no observed cutaneous or systemic side ef fects from corticosteroid therapy. We conclude that a history of prece ding scabies is common in patients with IA, but often this diagnosis i s made without microscopic confirmation. We also demonstrate that mid- to high-potency topical corticosteroids are a safe and effective firs t-line therapy for patients with IA.